Medicaid in focus as HHSC officials vetted

The Health and Human Services Commission’s top official, executive commissioner Kyle Janek, and the agency’s inspector general answered questions on the future of Medicaid Monday at a Senate nominations committee hearing Monday.

Janek, a Republican and former state representative and senator, was appointed last September by Gov. Rick Perry. At the hearing, the first step of confirmation for governor’s appointees, Sen. Jane Nelson asked Janek how he’d solve the state’s “Medicaid problem” if he could “wave a magic wand.”

“I’d like to look a little deeper into the business model of how we conduct managed care functions of Medicaid,” said Janek, an anesthesiologist. “Can we envision a business model where we go to the accountable care organizations and contract directly with them?”

Contracting directly with providers rather than a managed care organization, a group of providers that is managed by typically an insurance agency, would could cut out “service fees” charged by managed care organizations and could also decrease time-consuming and costly confusion, he said.

Nelson said Medicaid has grown from 11 percent of the state’s total budget in the early 1990s to about 30 percent now.

Janek seemed to be aware of the controversial nature of his post, although he received broad support from members of the committee including chair Glenn Hager, vice-chair Donna Campbell (an emergency room doctor), Nelson, and Sen. Kirk Watson, the lone Democrat on the panel.

“I really don’t have remarks but happy to answer any questions,” Janek said. “At this point, the best thing I can do is take a knee, run out the clock and get out the door but obviously that’s not the purpose.”

Douglas Wilson, who heads the investigative unit of the agency, was also vetted by committee members. He acknowledged the problem of Medicaid fraud. Wilson said the agency is improving its investigation techniques but said his agency needs more resources.

The Health and Human Services Commission conducted just 12 fraud investigations in fiscal year 2011 compared to 108 in fiscal year 2012, he said. The agency currently has about 400 open cases with some of them dating back four years. Each case takes an average of 10-12 weeks, he said.

“My office is all about compliance, making sure the dollars in the system are used for the intended purposes,” Wilson said. “We do have a problem but we are trying to get at it.”

Wilson said he has shifted priority of investigations to their dollar value rather than a first-come-first-serve approach, which has helped alleviate some of the building numbers.

Both appointees received “whole-hearted” support from Nelson and the committee voted unanimously to recommend their appointments to the full Senate for confirmation.